Amidst rising cases of bacterial STIs, what should health service providers do to support gay, bi, and queer men?

As GBQ guys, we have our own way of caring for our sexual health, including when it comes to bacterial STIs—what works for the general population isn’t always what works best for us. We need our healthcare providers to understand what’s unique about our sexual lives, at least well enough to prevent, diagnose, and treat bacterial STIs when they occur.

 Over the past decade, rates of gonorrhea, chlamydia and syphilis infection have increased in the general population in Canada.1 All three infections are easily curable, but shouldn’t be left untreated. Gonorrhea and chlamydia can increase the risk of contracting HIV while syphilis can lead to cardiovascular and neurological problems. For these reasons, healthcare providers need to know how to most-accurately diagnose STI cases in GBQ men.

To learn more, we tested guys in the Engage study for gonorrhea and chlamydia using throat and rectal swabs, as well as urine screening. Overall, 5.6% of guys had gonorrhea and 2.8% of had chlamydia.

Another important finding was that more guys tested positive for gonorrhea in the rectum (3.1%) and mouth (3.5%) compared to urine testing (0.4%). A similar trend was observed for chlamydia infections (2.4% in the rectum, 0.4% in the mouth, 0.4% in the genitals).2

Since non-genital bacterial STI infections often don’t cause symptoms, this means most bacterial infections in GBQ guys would be missed if healthcare providers only recommend a urine test for chlamydia and gonorrhea, which is typical when screening cis, straight men. It’s important that healthcare providers make sure their patients feel comfortable discussing their sexuality and their sexual history so that they can offer GBQ guys the right tests at routine checkups. 

Testing for STIs at non-genital sites is not the only way our sexual health needs are unique. In recent years, to prevent HIV, many of us have begun using HIV-pre-exposure prophylaxis (PrEP). While PrEP works extremely well to prevent HIV, it doesn’t protect us from bacterial STIs. 

Using Engage data, we investigated how PrEP use related to chances of getting bacterial STIs (chlamydia, gonorrhea, syphilis). We found that guys on PrEP were more likely to have anal sex without a condom and were diagnosed with more bacterial STIs. On average, guys on PrEP also had more anal sex partners with whom they had condomless sex, and this led to a higher risk of being diagnosed with a bacterial STI.3

These findings emphasize the importance of accessible and convenient STI testing for PrEP users. Trials are also underway to find out whether PrEP users can add antibiotics to their HIV-PrEP regimen to lower their increased risk of bacterial STIs.4,5 In the meantime, though, healthcare providers should take the time to discuss risk factors for bacterial STIs with their patients who are on PrEP. 

Using Engage data, we also explored how sexual health intersects with other aspects of our lives, including mental health. One particularly important STI risk factor for both PrEP users and non-PrEP users is depression. Guys experiencing depression who used stimulants (like cocaine or meth) were more likely to have condomless anal sex and had a higher chance of being diagnosed with an STI.6 These results tell us that access to affordable, evidence-based mental health services may improve sexual health, including when it comes to STI prevention. These findings also speak to the opportunities to combine sexual health and substance use services to reduce overall harms experienced by GBQ guys, including those who party and play (PnP). 

Of course, what it means to navigate sex and STI risk is unique to each person. For many, getting a bacterial STI is a small price to pay for having the sex they want to have. In any case, offering care that’s sensitive to differences in GBQ guys’ sexual lives will improve health outcomes and play a role in reducing inequities experienced in our communities. 


1.         Public Health Agency of Canada. Report on Sexually Transmitted Infection Surveillance in Canada, 2019 2021.

2.         Harvey-Lavoie S, Apelian H, Labbé AC, et al. Community-Based Prevalence Estimates of Chlamydia trachomatis and Neisseria gonorrhoeae Infections Among Gay, Bisexual, and Other Men Who Have Sex With Men in Montréal, Canada. Sex Transm Dis. Dec 1 2021;48(12):939-944. doi:10.1097/olq.0000000000001486

3.         Hart TA, Noor SW, Berlin GW, et al. Pre-exposure prophylaxis and bacterial sexually transmitted infections (STIs) among gay and bisexual men. Sex Transm Infect. Jun 14 2022;doi:10.1136/sextrans-2021-055381

4.         Grant JS, Stafylis C, Celum C, et al. Doxycycline Prophylaxis for Bacterial Sexually Transmitted Infections. Clin Infect Dis. Mar 3 2020;70(6):1247-1253. doi:10.1093/cid/ciz866

5.         Grennan T. Doxycycline Intervention for Bacterial STI ChemoprOphylaxis (DISCO). ClinicalTrialsgov. February 21, 2021 2021;doi:

6.         Hart TA, Noor S, Skakoon-Sparling S, et al. Depression is associated with bacterial sexually transmitted infections (STIs) among gay, bisexual, and other men who have sex with men (gbMSM). Canadian Association for HIV Research; 2020.

May 30th, 2023